SAFETY NETTING CONCEPT IN PRIMARY CARE CONSULTATION

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A.O. Ayodapo¹, T.M.M. Alanazi², O.T. Elegbede³, K.F. Monsudi⁴, A.O. Akinbode⁵, A.S. Ibraheem⁵

1. South Faisaliyah PHC and Trainer Saudi Board of Family Medicine, Arar, Saudi Arabia.
2. South-Faisaliyah PHC, Arar, Saudi Arabia.
3. Department of Family Medicine, Afe Babalola University Ado-Ekiti/Federal Teaching Hospital, Ido-Ekiti.
4. Department of Ophthalmology, Federal Medical Centre, Birnin-Kebbi, Nigeria.
5. Department of Family Medicine, Federal Medical Centre, Birnin kebbi, Nigeria.

Abstract

Introduction: Patient safety in primary care setting is important and effort geared towards this cannot be over-emphasised. Patient safety can be achieved through various means, but one mechanism to improve patient safety in resource constrained settings is through a practice known as safety netting. Safety netting is widely recommended in national guidelines with varying definitions and scope; hence there is no consensus on when safety netting should be used and what should be the content.

Methodology: A narrative overview of the evidence on safety netting concept in primary care consultation was conducted. Scholastic articles and Papers by International organizations were searched using terms like ‘safety netting’, ‘primary care consultation’, ‘family physician’, ‘consultation technique’, and ‘patient safety’ in primary care. Most resources found were in the developed countries (the West) and none was found in Africa or the Middle East. Safety netting is a technique in consultation to communicate uncertainty, provide patient information on red-flag symptoms, and plan for future appointments to ensure timely re-assessment of a patient’s condition. The content of safety netting advice may encompass the chronology of the illness, advice on worrying symptoms to look out for, and specific information on how, when and where to seek help. Safety netting was considered to be particularly important when consulting with the acutely unwell, patients with multi-morbidity, children and those with mental health problems.

Conclusion: Safety netting is more than solely the communication of uncertainty within a consultation. It should include plans for follow-up as well as important administrative aspects, such as the communication of test results. Effective safety netting should be geared towards the patient and provide enough practical clue for self-care and re-consultation.

Keywords: Consultation; Primary care; Safety netting; Uncertainty

Introduction

Safety netting is not a new concept, as it has received an increased attention globally, though same cannot be said about underdeveloped and developing countries in Africa and Middle East. Safety netting was first formally introduced more than 30 years ago by Roger Neighbour,¹ which today has undergone a lot of modifications in terms of context and content. At the centre of health care delivery is the patient; therefore, patient safety is paramount to primary care even though primary care is considered to be essentially safe.² It has also been estimated that 1 – 2% of consultations may lead to harm.3

One of the sure ways to increase patient safety, especially in resource-constraint settings is through a practice like safety netting. Safety netting is widely recommended in national guidelines (England, Wales and Scotland),^4-6 however, a variety of safety netting definitions exist with no unanimity in the context and contents.

Safety netting is now receiving increased attention particularly in the areas of early diagnosis of cancer and in consultations with children, where it is envisaged that it can potentially improve diagnostic and care pathways.⁷ Safety netting is seen differently by authors; while some see it as a consultation technique, others see it as more than that. The concept of safety netting is somewhat surmised as it can be used in different patient groups, diverse patient settings, and with different approach. It is also worthy of note that the concept may not be too relevant in the developed world, but as family physicians practicing in the underdeveloped and developing world where there is resource-constraint, the practice of safety netting may still be relevant.